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Mahmoudzadeh B, Mohammadian Y, Assar S, Ahmadi SM. Psychometric properties evaluation of the Persian version of the self-report outcome scale for lupus disease Lupus_PRO version 1.7. Lupus 2024; 33:1502-1510. [PMID: 39347655 DOI: 10.1177/09612033241288011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
PURPOSE Systemic Lupus Erythematosus (SLE) significantly affects both the quality of life related to health and non-health aspects. This study aims to evaluate the psychometric properties of the Persian version of the Lupus_PRO questionnaire, version 1.7. The questionnaire serves as a specific self-report outcome scale for assessing the treatment outcomes of Lupus disease. METHODS The Lupus_PRO questionnaire, version 1.7, was translated into Persian using the standard forward-backward method. After being completed by 218 patients with Lupus, the psychometric properties of the instrument were examined. The Convergent and Discriminant Validity of the scale were assessed using Average Variance Extracted and Cross Loadings, respectively. The construct validity of the questionnaire was also evaluated through Confirmatory Factor Analysis (CFA). Cronbach's alpha was calculated to assess the reliability of the questionnaire dimensions. FINDINGS Out of the 218 patients with lupus who participated in the current study, 13 (6%) were male, and 205 (94%) were female. The mean (SD) age of participants was 40.29 (10.94) years. The Average Variance Extracted (AVE) for HRQOL and Non-HRQOL constructs, except for the Coping and Cognition dimension, was greater than 0.50, indicating satisfactory convergent validity. The interdimensional correlation coefficient (Discriminant Validity) for each dimension with other questionnaire dimensions was less than 0.10, indicating that the questionnaire has good convergent and discriminant validity. Additionally, the results of the Confirmatory Factor Analysis (CFA) indicated that the questionnaire was a suitable fit. In terms of reliability, Cronbach's alpha for the various questionnaire dimensions ranged from 0.51 to 0.91, indicating good internal consistency. CONCLUSION The Persian version of the Lupus_PRO questionnaire, version 1.7, demonstrates acceptable validity and reliability in the Iranian population. This instrument can effectively measure various aspects of the quality of life in patients with lupus.
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Affiliation(s)
- Bahareh Mahmoudzadeh
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Youkhabeh Mohammadian
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shirin Assar
- Clinical Research Development Center, Imam Reza Hospital, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyyed Mojtaba Ahmadi
- Department of Clinical Psychology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Karabukayeva A, Hearld LR, Choi S, Singh JA. Patient Perspectives on a Decision Aid for Systemic Lupus Erythematosus: Insights and Future Considerations. J Rheumatol 2024; 51:798-803. [PMID: 38749565 DOI: 10.3899/jrheum.2023-1178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with a wide spectrum of clinical manifestations. A decision aid (DA) for SLE was developed and implemented in 15 rheumatology clinics throughout the United States. This study explored the experiences of patients who viewed the DA to understand how patients engage with and respond to the SLE DA. METHODS We conducted a qualitative descriptive study using semistructured interviews with a convenience sample of 24 patients during May to July 2022. RESULTS Patients recognized the value of the SLE DA in providing general knowledge about SLE and different treatment options. However, patients expressed a desire for more comprehensive lifestyle information to better manage their condition. Another theme was the importance of having multiple formats available to cater to their different needs, as well as tailoring the DA to different stages of SLE. CONCLUSION This study contributes to a broader understanding of how to provide patient-centered care for patients with SLE by offering practical insights that can inform the development of more effective, patient-centric health information technologies for managing chronic diseases, ultimately improving patient outcomes. Overall, this study underscores the significance of optimizing both the information content and determining the appropriate delivery of the tool for its future sustainability.
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Affiliation(s)
- Aizhan Karabukayeva
- A. Karabukayeva, PhD, Health Administration and Policy, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma;
| | - Larry R Hearld
- L.R. Hearld, PhD, Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham (UAB), Birmingham, Alabama
| | - Seongwon Choi
- S. Choi, PhD, Department of Management, College of Business and Economics, California State University Los Angeles, Los Angeles, California
| | - Jasvinder A Singh
- J.A. Singh, MD, MPH, Division of Immunology and Rheumatology, Heersink School of Medicine, UAB, Medicine Service and Geriatric Research Education and Clinical Center (GRECC), VA Medical Center, Department of Medicine at the School of Medicine, UAB, and Department of Epidemiology, UAB School of Public Health, Birmingham, Alabama, USA.
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Elefante E, Gualtieri L, Schilirò D, Stagnaro C, Signorini V, Zucchi D, Cardelli C, Carli L, Ferro F, Tani C, Mosca M. Impact of disease activity patterns on health-related quality of life (HRQoL) in patients with systemic lupus erythematosus (SLE). Lupus Sci Med 2024; 11:e001202. [PMID: 39074950 PMCID: PMC11288148 DOI: 10.1136/lupus-2024-001202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 07/04/2024] [Indexed: 07/31/2024]
Abstract
OBJECTIVE To assess the impact of different disease activity patterns-long quiescent (LQ), chronically active (CA) and relapsing-remitting (RR)-on health-related quality of life (HRQoL) in a cohort of patients with systemic lupus erythematosus (SLE). METHODS A retrospective, monocentric analysis of prospectively collected data. Adult SLE outpatients were enrolled between 2017 and 2021.For each year of follow-up, three disease activity patterns were defined: LQ if at each visit clinical Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus Activity Index (SELENA-SLEDAI)=0, Physician Global Assessment (PGA)=0; CA if at each visit clinical SELENA-SLEDAI >0, PGA >0; RR if patients presented active disease in at least one visit during the observation period, interspersed with periods of remission. These patterns were applied to the year and the 3 years before enrolment.At enrolment, each patient completed: Short Form 36 (SF-36), Lupus Impact Tracker, Functional Assessment of Chronic Illness Therapy (FACIT), Hospital Anxiety and Depression Scale (HADS). The correlation between disease patterns and Patient-Reported Outcomes was analysed. RESULTS 241 SLE patients were enrolled, of which 222 had complete clinical data for the 3-year period before enrolment. Both in the year and during the 3 years before enrolment, the most frequent disease pattern was the LQ (154/241 and 122/222 patients, respectively), followed by RR (53/241 and 92/222 patients, respectively) and CA (34/241 and 8/222 patients, respectively).At baseline, fibromyalgia, organ damage, age and daily glucocorticoid dose were associated with worse HRQoL.At the multivariable analysis, after adjusting for confounding factors, patients with LQ disease during the 3 years before enrolment presented a better physical HRQoL (SF-36 physical component summary, regression coefficient=3.2, 95% CI 0.51-5.89, p=0.02) and minor depressive symptoms (HADS-D, regression coefficient=-1.17, 95% CI -2.38 to 0.0.27, p=0.055), compared with patients with CA/RR disease. CONCLUSION A persistently quiescent disease may have a positive impact on patients' physical HRQoL and on depressive symptoms. However, this condition appears insufficient to obtain a significant improvement in mental health, fatigue and disease burden among patients with SLE.
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Affiliation(s)
| | | | | | | | | | - Dina Zucchi
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | | | - Linda Carli
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | | | - Chiara Tani
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, University of Pisa, Pisa, Italy
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Mysler E, Monticielo OA, Al-Homood IA, Lau CS, Hussein H, Chen YH. Opportunities and challenges of lupus care in Latin America, the Middle East, and Asia-Pacific: A call to action. Mod Rheumatol 2024; 34:655-669. [PMID: 38531074 DOI: 10.1093/mr/roae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/27/2023] [Indexed: 03/28/2024]
Abstract
Lupus remains a disease with a low prioritisation in the national agendas of many countries in Latin America, the Middle East, and Asia-Pacific, where there is a dearth of rheumatologists and limited access to new or even standard lupus treatments. There is thus an important need for education, advocacy, and outreach to prioritise lupus in these regions to ensure that patients receive the care they need. This article reviews some of the specific challenges facing the care and management of people with lupus in these regions and suggests strategies for improving patient outcomes. Specifically, we review and discuss (with a focus on the aforementioned regions) the epidemiology of lupus; economic costs, disease burden, and effects on quality of life; barriers to care related to disease assessment; barriers to effective treatment, including limitations of standard treatments, high glucocorticoid use, inadequate access to new treatments, and low adherence to medications; and strategies to improve lupus management and patient outcomes. We hope that this represents a call to action to come together and act now for the lupus community, policymakers, health authorities, and healthcare professionals to improve lupus management and patient outcomes in Latin America, the Middle East, and Asia-Pacific.
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Affiliation(s)
- Eduardo Mysler
- Organización Medica de Investigación, Buenos Aires, Argentina
| | - Odirlei Andre Monticielo
- Rheumatology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Chak Sing Lau
- Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China
| | | | - Yi-Hsing Chen
- Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China
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Huot S, Fortin PR, Godbout A, Laflamme C, Pouliot M. A tool to assist rheumatologists to engage their lupus patients: the Purple Butterfly. Rheumatol Adv Pract 2024; 8:rkae075. [PMID: 38915844 PMCID: PMC11194531 DOI: 10.1093/rap/rkae075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/22/2024] [Indexed: 06/26/2024] Open
Abstract
Objective Translating the highly technical medical jargon of SLE into understandable concepts for patients, their families and individuals without expertise in SLE is a serious challenge. To facilitate communication and enable self-management in SLE, we aimed to create an innovative visual tool, the Purple Butterfly. Methods We selected clinically representative criteria for SLE and transposed them as graphical features in an attractive and meaningful visual. We developed a script in R programming language that automatically transposes clinical data into this visualization. We asked SLE patients from a local cohort about the relevance, usefulness and acceptability of this visual tool in an online pilot survey. Results The innovative Purple Butterfly features 11 key clinical criteria: age; sex; organ damage; disease activity; comorbidities; use of antimalarials, prednisone, immunosuppressants and biologics; and patient-reported physical and mental health-related quality of life. Each Purple Butterfly provides the health portrait of one SLE patient at one medical visit, and the automatic compilation of the butterflies can illustrate a patient's clinical journey over time. All survey participants agreed that they would like to use the Purple Butterfly to visualize the course of their SLE over time, and 9 of 10 agreed it should be used during their medical consultations. Conclusion The Purple Butterfly nurtures effective doctor-patient communication by providing concise visual summaries of lupus patients' health conditions. We believe the Purple Butterfly has the potential to empower patients to take charge of their condition, enhance healthcare coordination and raise awareness about SLE.
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Affiliation(s)
- Sandrine Huot
- Département de Microbiologie-Infectiologie et Immunologie, Université Laval, Québec, Canada
- Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada
- Centre ARThrite-UL, Québec, Canada
| | - Paul R Fortin
- Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada
- Centre ARThrite-UL, Québec, Canada
- Division de Rhumatologie, Département de Médecine Spécialisée, CHU de Québec-Université Laval, Québec, Canada
| | | | - Cynthia Laflamme
- Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada
- Centre ARThrite-UL, Québec, Canada
| | - Marc Pouliot
- Département de Microbiologie-Infectiologie et Immunologie, Université Laval, Québec, Canada
- Axe Maladies Infectieuses et Immunitaires, Centre de Recherche du CHU de Québec-Université Laval, Québec, Canada
- Centre ARThrite-UL, Québec, Canada
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Bertsias G, Fanouriakis A, Bartsakoulia M, Galanakis P, Boumpas DT. The NYMERIA Study: A Real-World, Multicentre Contemporary Assessment of Disease- and Patient-Related Burden and Treatment Strategies in Patients with Systemic Lupus Erythematosus. Mediterr J Rheumatol 2024; 35:392-401. [PMID: 39193181 PMCID: PMC11345607 DOI: 10.31138/mjr.160524.tns] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 08/29/2024] Open
Abstract
Systemic lupus erythematosus (SLE) has a spectrum of phenotypes. Its management should target remission or low disease activity, prevention of relapses and organ damage, minimisation of drug-related harms, and optimisation of health-related quality of life. Advances in our understanding of the disease pathophysiology have expanded the treatment armamentarium with targeted biologics that demonstrate superiority over conventional drugs in controlling activity, reducing flares and glucocorticoid exposure, and improving patient-related outcomes. In view of this, there is a critical need for real-world evidence providing insight into the spectrum of activity, the treatment landscape, and unmet needs among SLE patients. Such information can support regulatory and reimbursement decision-making. The primary objective of the NYMERIA multicentre study is to generate real-world evidence on the activity state of SLE patients treated in routine care settings in Greece. The overarching aim is to capture the disease burden based on both clinical aspects and the patient perspective.
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Affiliation(s)
- George Bertsias
- Rheumatology and Clinical Immunology, University of Crete Medical School, Heraklion, Greece
- Division of Immunity, Institute of Molecular Biology and Biotechnology-Foundation for Research and Technology – Hellas (FORTH), Heraklion, Greece
| | - Antonis Fanouriakis
- Rheumatology and Clinical Immunology Unit, “Attikon” University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Petros Galanakis
- Medical Department Respiratory & Immunology AstraZeneca, Athens, Greece
| | - Dimitrios T. Boumpas
- Rheumatology and Clinical Immunology Unit, “Attikon” University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Laboratory of Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
- Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Greece, Medical School, University of Cyprus, Nicosia, Cyprus
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Thibault T, Rajillah A, Bourredjem A, Corneloup M, Maurier F, Wahl D, Muller G, Aumaitre O, Sève P, Blaison G, Besancenot JF, Martin T, Magy-Bertrand N, Samson M, Arnaud L, Amoura Z, Devilliers H. Health-related quality of life, remission and low lupus disease activity state in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2024; 63:1447-1455. [PMID: 37589711 DOI: 10.1093/rheumatology/kead407] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/10/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES To measure the association between SLE remission and scores of patients-reported outcome (PRO) measures. METHODS We performed a prospective cohort study of SLE patients with a 2-year follow-up, using Lupus Patient-Reported Outcome (LupusPRO), Lupus Quality of Life (LupusQoL), Systemic Lupus Erythematosus Quality of Life (SLEQOL) and 36-item Short Form (SF-36) questionnaires. Remission was defined as remission off treatment (ROFT) and remission on treatment (RONT) according to the definitions of remission in SLE consensus. Mixed models accounting for repeated measures were used to compare groups as follow: ROFT and RONT vs no remission and lupus low disease activity state (LLDAS) vs no LLDAS. RESULTS A total of 1478 medical visits and 2547 PRO questionnaires were collected during the follow-up from the 336 recruited patients. A between-group difference in PRO scores reaching at least 5 points on a 0-100 scale was obtained in the following domains: lupus symptoms (LLDAS: +5 points on the 0-100 scale, RONT: +9, ROFT: +5), lupus medication (LLDAS: +5, RONT: +8, ROFT: +9), pain vitality (LLDAS: +6, RONT: +9, ROFT: +6) of LupusPRO; role emotional (LLDAS: +5, RONT: +8), role physical (RONT: +7 and ROFT: +7), bodily pain (RONT: +6), mental health (RONT: +5) and social functioning (RONT: +6) of SF-36. In contrast, a between-group difference reaching at least 5 points was not achieved for any of the LupusQoL and SLEQOL domains. CONCLUSIONS RONT, ROFT and LLDAS were associated with significant and clinically relevant higher QoL in most PRO domains of the LupusPRO (disease specific) and SF-36 (generic) questionnaires, but not with LupusQoL and SLEQOL disease-specific questionnaires.
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Affiliation(s)
- Thomas Thibault
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - Abdessamad Rajillah
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Abderrahmane Bourredjem
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - Marie Corneloup
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
| | - François Maurier
- Department of Internal Medicine and Clinical Immunology, Hôpital Robert Schuman, Metz-Vantoux, 57070, France
| | - Denis Wahl
- Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Inserm UMR_S 1116, CHRU de Nancy, University of Lorraine, Nancy, France
| | - Geraldine Muller
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Olivier Aumaitre
- Department of Internal Medicine, Centre Hospitalier Universitaire, Hôpital Gabriel Montpied, Clermont-Ferrand, France
| | - Pascal Sève
- Department of Internal Medicine, Lyon University Hospital, Hôpital Croix Rousse, Lyon, France
- Research on Healthcare Performance, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Gilles Blaison
- Department of Internal Medicine, Hôpital Louis Pasteur, Colmar, France
| | | | - Thierry Martin
- Internal Medicine and Clinical Immunology Department, Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Strasbourg University Hospital, Strasbourg, France
| | - Nadine Magy-Bertrand
- Department of Internal Medicine, University Hospital Jean Minjoz, Besançon, France
| | - Maxime Samson
- Internal Medicine and Clinical Immunology Unit, University Hospital Dijon-Burgundy, Dijon, France
| | - Laurent Arnaud
- Department of Rheumatology, Centre National de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- INSERM UMR-S 1109, Strasbourg, France
| | - Zahir Amoura
- Department of Internal Medicine, National Referral Center for Systemic Lupus Erythematosus and Anti-Phospholipid Syndrome, Pitié-Salpêtrière University Hospital, Paris, France
| | - Hervé Devilliers
- Internal Medicine and Systemic Diseases Unit, University Hospital Dijon-Burgundy, Dijon, France
- Clinical Investigation Center, INSERM CIC-EC 1432, University Hospital Dijon-Burgundy, Dijon, France
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Bartol-Puyal FDA, Chacón González M, Arias-Peso B, García Navarro D, Méndez-Martínez S, Ruiz del Tiempo MP, Sáez Comet L, Pablo Júlvez L. Vision-Related Quality of Life in Patients with Systemic Lupus Erythematosus. Healthcare (Basel) 2024; 12:540. [PMID: 38470651 PMCID: PMC10931292 DOI: 10.3390/healthcare12050540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/22/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024] Open
Abstract
PURPOSE To assess vision-related quality of life (VRQoL) in patients with systemic lupus erythematosus (SLE) under treatment with hydroxychloroquine (HCQ), and to find the influencing factors. METHODS Cross-sectional study enrolling SLE patients for less than ten years (Group 1), SLE patients for more than ten years (Group 2), and healthy controls (Group 3). SLE patients should be under treatment with HCQ but without ophthalmological affection. Schirmer test, best-corrected visual acuity (BCVA), axial length (AL) with optical biometry, and swept-source optical coherence tomography-angiography (OCTA) Triton (Topcon) were performed. All participants fulfilled the Impact of Visual Impairment questionnaire, and SLE patients answered the Lupus Impact Tracker (LIT) questionnaire. Additional data were obtained from clinical records. RESULTS A totals of 41 eyes (41 patients), 31 eyes (31 patients) and 45 eyes (45 volunteers) were enrolled in the study groups. The mean ages were 41.09 ± 9.56, 45.06 ± 8.47 and 40.25 ± 10.83 years, respectively (p = 0.10). The LIT outcomes were 33.49 ± 20.74 and 35.98 ± 22.66 (p = 0.63), respectively. Group 3 referred to a better VRQoL than Group 2 in all categories and than Group 1 in some of them. A linear regression analysis showed that serum ferritin, SLE activity scales, body-mass index (BMI), age, and BCVA influenced VRQoL. The LIT questionnaire was correlated to two categories of the Impact of Visual Impairment questionnaire (IVI). CONCLUSIONS Despite no ophthalmological affection, SLE patients refer to poorer VRQoL because of disease activity and a low health-related quality of life, which has a negative influence on VRQoL. This masks the effect of other ophthalmological conditions such as dry eyes. Other variables influencing VRQoL are age and BMI, and BCVA, to a lesser extent.
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Affiliation(s)
- Francisco de Asís Bartol-Puyal
- Ophthalmology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Miguel Servet Ophthalmology Research Group (GIMSO), Aragón Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
- Surgery Department, Universidad de Zaragoza, 50018 Zaragoza, Spain
| | - María Chacón González
- Ophthalmology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Miguel Servet Ophthalmology Research Group (GIMSO), Aragón Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
| | - Borja Arias-Peso
- Ophthalmology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Miguel Servet Ophthalmology Research Group (GIMSO), Aragón Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
| | - Damián García Navarro
- Ophthalmology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Miguel Servet Ophthalmology Research Group (GIMSO), Aragón Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
| | - Silvia Méndez-Martínez
- Ophthalmology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Miguel Servet Ophthalmology Research Group (GIMSO), Aragón Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
| | - María Pilar Ruiz del Tiempo
- Ophthalmology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Miguel Servet Ophthalmology Research Group (GIMSO), Aragón Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
| | - Luis Sáez Comet
- Internal Medicine Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
| | - Luis Pablo Júlvez
- Ophthalmology Department, Miguel Servet University Hospital, 50009 Zaragoza, Spain
- Miguel Servet Ophthalmology Research Group (GIMSO), Aragón Institute for Health Research (IIS Aragón), 50009 Zaragoza, Spain
- Surgery Department, Universidad de Zaragoza, 50018 Zaragoza, Spain
- Biotech Vision SLP, University of Zaragoza, 50009 Zaragoza, Spain
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Spies E, Andreu T, Hartung M, Park J, Kamudoni P. Exploring the Perspectives of Patients Living With Lupus: Retrospective Social Listening Study. JMIR Form Res 2024; 8:e52768. [PMID: 38306157 PMCID: PMC10873798 DOI: 10.2196/52768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease affecting various organs with a wide range of clinical manifestations. Cutaneous lupus erythematosus (CLE) can manifest as a feature of SLE or an independent skin ailment. Health-related quality of life (HRQoL) is frequently compromised in individuals living with lupus. Understanding patients' perspectives when living with a disease is crucial for effectively meeting their unmet needs. Social listening is a promising new method that can provide insights into the experiences of patients living with their disease (lupus) and leverage these insights to inform drug development strategies for addressing their unmet needs. OBJECTIVE The objective of this study is to explore the experience of patients living with SLE and CLE, including their disease and treatment experiences, HRQoL, and unmet needs, as discussed in web-based social media platforms such as blogs and forums. METHODS A retrospective exploratory social listening study was conducted across 13 publicly available English-language social media platforms from October 2019 to January 2022. Data were processed using natural language processing and knowledge graph tagging technology to clean, format, anonymize, and annotate them algorithmically before feeding them to Pharos, a Semalytix proprietary data visualization and analysis platform, for further analysis. Pharos was used to generate descriptive data statistics, providing insights into the magnitude of individual patient experience variables, their differences in the magnitude of variables, and the associations between algorithmically tagged variables. RESULTS A total of 45,554 posts from 3834 individuals who were algorithmically identified as patients with lupus were included in this study. Among them, 1925 (authoring 5636 posts) and 106 (authoring 243 posts) patients were identified as having SLE and CLE, respectively. Patients frequently mentioned various symptoms in relation to SLE and CLE including pain, fatigue, and rashes; pain and fatigue were identified as the main drivers of HRQoL impairment. The most affected aspects of HRQoL included "mobility," "cognitive capabilities," "recreation and leisure," and "sleep and rest." Existing pharmacological interventions poorly managed the most burdensome symptoms of lupus. Conversely, nonpharmacological treatments, such as exercise and meditation, were frequently associated with HRQoL improvement. CONCLUSIONS Patients with lupus reported a complex interplay of symptoms and HRQoL aspects that negatively influenced one another. This study demonstrates that social listening is an effective method to gather insights into patients' experiences, preferences, and unmet needs, which can be considered during the drug development process to develop effective therapies and improve disease management.
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Affiliation(s)
| | | | | | | | - Paul Kamudoni
- The Healthcare Business of Merck KGaA, Darmstadt, Germany
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Elefante E, Cornet A, Andersen J, Somers A, Mosca M. The communication GAP between patients and clinicians and the importance of patient reported outcomes in Systemic Lupus Erythematosus. Best Pract Res Clin Rheumatol 2023; 37:101939. [PMID: 38485601 DOI: 10.1016/j.berh.2024.101939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/20/2024] [Indexed: 06/23/2024]
Abstract
Systemic Lupus Erythematosus (SLE) imposes a great burden on the lives of patients. Patients' and physicians' concerns about the disease diverge considerably. Physicians focus on controlling disease activity to prevent damage accrual, while patients focus on symptoms that impact on Health-Related Quality of Life (HRQoL). We explored the physicians' and patients' perspective and the potential role of Patient Reported Outcomes (PROs). Physicians are aware of the theoretical usefulness of PROs to collect information deriving from the patients' perspective. However, they often do not know how to interpret and use these questionnaires in a real shared therapeutic strategy. For the patients, it's important to be seen as a whole person with a true consideration of how they feel and function. Strategies to help bridge the communication gap could include: better use of time during visits, preparing for the consultation, a more understandable lay language used by the doctor, a dedicated nurse.
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Affiliation(s)
- Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, Italy
| | | | | | | | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Pisana, Italy.
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11
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Fujita Y, Iwata S, Hidese S, Ishiwata S, Ide S, Tanaka H, Sonomoto K, Miyazaki Y, Nakayamada S, Ikenouchi A, Hattori K, Kunugi H, Yoshimura R, Tanaka Y. Reduced homovanillic acid, SDF-1α and SCGF-β levels in cerebrospinal fluid are related to depressive states in systemic lupus erythematosus. Rheumatology (Oxford) 2023; 62:3490-3500. [PMID: 36852847 DOI: 10.1093/rheumatology/kead091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE This study aimed to seek a new method of evaluation and surrogate markers for diffuse neuropsychiatric SLE (NPSLE). METHODS We enrolled 44 patients with SLE between 2017 and 2020 who fulfilled at least one of three specific inclusion criteria: high disease activity, abnormal findings (cerebrospinal fluid [CSF] examination, brain MRI, or electroencephalography), or history of neuropsychiatric illness. Psychiatric symptom rating scales (PSYRATS) were evaluated retrospectively. The primary end point was the PSYRATS positivity rate in SLE patients who had not been diagnosed with diffuse NPSLE. RESULTS Based on the 1999 ACR classifications, 7 out of the 44 patients evaluated using PSYRATS had been diagnosed with diffuse NPSLE. PSYRATS positivity was seen in 13 out of 37 SLE patients (35.1%) who had not been diagnosed with diffuse NPSLE, and all these patients were positive for Montgomery-Åsberg Depression Rating Scale (MADRS), an indicator of depression state in PSYRATS. Additionally, in the 20 SLE patients exhibiting depression symptoms who were MADRS-positive, CSF concentrations of the neuroinflammatory markers homovanillic acid (HVA; P = 0.0400), stromal cell-derived factor-1α (SDF-1α; P = 0.0431) and stem cell growth factor-β (SCGF-1β; P = 0.0061) were significantly reduced compared with the 24 MADRS-negative SLE patients, and the levels of HVA, SDF-1α and SCGF-1β correlated with one another (P < 0.05). CONCLUSION Many patients with active SLE have subclinical depression, and MADRS evaluation of neuropsychiatric symptoms is useful for detecting them. Additionally, the decrease in CSF levels of HVA, SDF-1 α and SCGF-1β reflects the same pathology, and these may serve as surrogate markers.
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Affiliation(s)
- Yuya Fujita
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shigeru Iwata
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Rheumatology and Clinical Immunology, Wakayama Medical University, Wakayama, Japan
| | - Shinsuke Hidese
- Department of Mental Disorder Research, National Institute of Neuroscience, National Centre of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Sayuri Ishiwata
- Department of Mental Disorder Research, National Institute of Neuroscience, National Centre of Neurology and Psychiatry, Tokyo, Japan
| | - Satoru Ide
- Department of Radiology, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Hiroaki Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Koshiro Sonomoto
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yusuke Miyazaki
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shingo Nakayamada
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Atsuko Ikenouchi
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
- Medical Center for Dementia, Hospital of the University of Occupational and Environmental Health, Fukuoka, Japan
| | - Kotaro Hattori
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
- Department of Bioresources, Medical Genome Center, National Centre of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Centre of Neurology and Psychiatry, Tokyo, Japan
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Reiji Yoshimura
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
| | - Yoshiya Tanaka
- First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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12
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Papachristodoulou E, Kakoullis L, Christophi C, Psarelis S, Hajiroussos V, Parperis K. The relationship of neutrophil-to-lymphocyte ratio with health-related quality of life, depression, and disease activity in SLE: a cross-sectional study. Rheumatol Int 2023; 43:1841-1848. [PMID: 37405441 PMCID: PMC10435585 DOI: 10.1007/s00296-023-05381-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/22/2023] [Indexed: 07/06/2023]
Abstract
The neutrophil-to-lymphocyte ratio (NLR) emerged as a potential biomarker in SLE, but its association with several outcomes remains unclear. We aimed to evaluate the relationship between NLR and SLE disease activity, damage, depression, and health-related quality of life. A cross-sectional study was conducted, including 134 patients with SLE who visited the Division of Rheumatology between November 2019 and June 2021. Demographics and clinical data including NLR, Safety of Estrogens in Lupus Erythematosus National Assessment-Systemic Lupus disease activity index (SELENA-SLEDAI), Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), physician global assessment (PhGA), patient global assessment (PGA), patient health questionnaire (PHQ)-9, patient self-rated health, and lupus quality of life (LupusQoL) scores, were collected. Patients were stratified into two groups and compared using the NLR cut-off of 2.73, the 90th percentile value of healthy individuals. The analysis included t-test for continuous variables, χ2-test for categorical variables, and logistic regression adjusting for age, sex, BMI, and glucocorticoid use. Among the 134 SLE patients, 47 (35%) had an NLR ≥ 2.73. The NLR ≥ 2.73 group had significantly higher rates of severe depression (PHQ ≥ 15), poor/fair self-rated health, and the presence of damage (SDI ≥ 1). These patients also scored significantly lower in LupusQoL domains (physical health, planning, and body image), and higher in SELENA-SLEDAI, PhGA, and PGA. Logistic regression confirmed that high NLR is associated with severe depression (PHQ ≥ 15) (OR:7.23, 2.03-25.74), poor/fair self-rated health (OR:2.77,1.29-5.96), high SELENA-SLEDAI score(≥ 4) (OR:2.22,1.03-4.78), high PhGA (≥ 2) (OR:3.76, 1.56-9.05), and presence of damage (SDI ≥ 1) (OR:2.67, 1.11-6.43). High NLR in SLE may indicate depression, worse quality of life, active disease, and the presence of damage.
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Affiliation(s)
- Eleni Papachristodoulou
- Department of Medicine, University of Cyprus Medical School, Nicosia, Cyprus
- Department of Medicine, University of Patras School of Health Sciences, Patras, Greece
| | - Loukas Kakoullis
- Department of Internal Medicine, Mount Auburn Hospital, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Costas Christophi
- Department of Biostatistics and Epidemiology, Cyprus University of Technology, Limassol, Cyprus
| | - Savvas Psarelis
- Department of Rheumatology, Nicosia General Hospital, University of Cyprus Medical School, Nicosia, Cyprus
| | | | - Konstantinos Parperis
- Department of Internal Medicine, Division of Rheumatology, University of Cyprus Medical School, Palaios Dromos Lefkosias Lemesou No. 215/6, Aglantzia, 2029, Nicosia,, Cyprus.
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Zucchi D, Cardelli C, Elefante E, Tani C, Mosca M. Treat-to-Target in Systemic Lupus Erythematosus: Reality or Pipe Dream. J Clin Med 2023; 12:jcm12093348. [PMID: 37176788 PMCID: PMC10178979 DOI: 10.3390/jcm12093348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/02/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023] Open
Abstract
Treat-to-target is a therapeutic approach based on adjustments to treatment at set intervals in order to achieve well-defined, clinically relevant targets. This approach has been successfully applied to many chronic conditions, and in rheumatology promising results have emerged for rheumatoid arthritis. For systemic lupus erythematosus (SLE), defining the most meaningful treatment targets has been challenging, due to disease complexity and heterogeneity. Control of disease activity, the reduction of damage accrual and the patient's quality of life should be considered as the main targets in SLE, and several new drugs are emerging to achieve these targets. This review is focused on describing the target to achieve in SLE and the methods to do so, and it is also aimed at discussing if treat-to-target could be a promising approach also for this complex disease.
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Affiliation(s)
- Dina Zucchi
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Chiara Cardelli
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
| | - Elena Elefante
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Marta Mosca
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Ferrara V, Perrone ME, Mina C, Ceccarelli F, Olivieri G, Fattapposta F, Conti F. Science and visual Arts: Binomial or Dichotomy? A Pilot study in Systemic Lupus Erythematosus patients. Lupus 2022; 31:1744-1749. [PMID: 36189670 DOI: 10.1177/09612033221131179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2022]
Abstract
Scientific literature demonstrated the impairment in cognitive/executive functions and pragmatic language in SLE patients, potentially involving also asymptomatic subjects. The present study focuses on the assessment in an SLE cohort of emotional intelligence, which is an ability regulated by the network of the executive functions, cognitive abilities involved in the initiation, planning, organization, and regulation of achievement-oriented behaviors: with emotional. Thus, emotional intelligence, defined as the ability to reason with emotions, was evaluated in a SLE cohort diagnosed according to the 1997 American College of Rheumatology criteria. As control healthy subjects were enrolled. The Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), a skill-scale that measures the ability to perform tasks and solve emotional problems, was administered to patients and controls. Second, a group of SLE patients underwent the Visual Thinking Strategies (VTS) method in order to assess the potential impact of art in cognitive skills like critical thinking, problem solving, and emotional intelligence quotient. The protocol also included the evaluation of the improvement of some skills using a validated VTS skill grid. Self-reported scales for anxiety and depression were performed to rule out the influence of mood disorders on emotional intelligence. The present study demonstrated similar quotient scores of emotional intelligence in SLE patients and healthy controls. Furthermore, VTS method could help in improving this cognitive ability in patients, by implementing critical thinking and problem solving, promoting empathy, and improving tolerance to ambiguity and relational capacity.
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Affiliation(s)
- Vincenza Ferrara
- Art and Medical Humanities Lab - Pharmacy and Medicine Faculty, Sapienza University of Rome, Roma, Italy
| | | | - Concetta Mina
- Human Neurosciences Department Sapienza, University of Rome, Rome, Italy
| | - Fulvia Ceccarelli
- Lupus Clinic, Reumatology, Clinical Internal, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Giulio Olivieri
- Lupus Clinic, Reumatology, Clinical Internal, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | | | - Fabrizio Conti
- Lupus Clinic, Reumatology, Clinical Internal, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
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15
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Jones MM, Kimble LP. Body Image, Depression Symptoms, and Health-Related Quality of Life in Black Women With Systemic Lupus Erythematosus. Nurs Womens Health 2022; 26:363-370. [PMID: 36002068 PMCID: PMC9659411 DOI: 10.1016/j.nwh.2022.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 07/10/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To examine relationships among body image, depression symptoms, and quality of life in Black women with systemic lupus erythematosus (SLE). DESIGN Descriptive, correlational design. SETTING/SAMPLE Using social media advertising, we recruited Black women with self-reported SLE to complete a web-based survey. RESULTS The female sample (N = 43) was predominantly non-Hispanic (80%) and married (58%), with a mean age of 33.5 (SD = 6.9) years. The mean time since SLE diagnosis was 5.9 (SD = 4.0) years. The majority of respondents (51%) reported using oral steroid therapy for disease control. Mean body image and depression scores, 2.0 (SD = 0.6) and 62.4 (SD = 8.5), respectively, differed from population norms of 1.80 (SD = 0.9) and 50 (SD = 10), indicating greater body image disturbance and greater depression symptoms than reported by the general population. Greater body image disturbance was significantly associated with greater depression symptoms and poorer quality of life in the area of role disruption. CONCLUSION Depression and body image disturbance among Black women with SLE should be routinely assessed and addressed by nurses and other clinicians to help promote optimal quality of life.
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16
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Han JY, Cho SK, Nam E, Kim H, Lee SS, Jolly M, Sung YK. Korean LupusPRO: Cross-Cultural validation study for systemic lupus erythematosus. Lupus 2022; 31:1498-1507. [PMID: 36017605 DOI: 10.1177/09612033221122984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To establish the reliability and validity of the Korean version of LupusPRO version 1.7 (v1.7) for systemic lupus erythematosus (SLE) patients. METHODS LupusPRO v1.7 was translated into Korean, followed by pretesting among five native Korean speakers. We administered the LupusPRO v1.7 survey to five SLE patients and made minor changes to clarify the language. Then, 133 SLE patients participated in the validation procedure. In each domain, the internal consistency reliability (ICR) and test-retest reliability (TRR) were assessed using Cronbach's alpha and the intra-class correlation coefficient (ICC), respectively. Criterion validity was evaluated using Spearman's correlation coefficient with the other measures such as SF-36, EQ-5D VAS, and SELENA-SLEDAI PGA. Construct validity was assessed by confirmatory factor analysis (CFA) using the unweighted least square estimation method. RESULTS The mean age of the 133 patients was 36.14 years, and 97% of them were women. Analysis of 130 returned questionnaires revealed that most ICRs of the Korean LupusPRO v1.7 domains were acceptable, with Cronbach's alphas in the range of 0.579-0.949, and most TRRs were good with ICCs from 0.582 to 0.851. Criterion validities presented significant correlations between the LupusPRO v1.7 and other measures validated. In the analysis of the CFA model, the goodness of fit indices demonstrated an acceptable fit. Factor loadings for most individual items were between 0.548 and 0.985. The average variance extracted (AVE) and composite reliability (CR) of most domains were greater than 0.5 and 0.7, respectively, demonstrating acceptable convergent and discriminant validities. CONCLUSIONS The Korean version of LupusPRO v.17 had acceptable reliability and validity.
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Affiliation(s)
- Jung-Yong Han
- Department of Rheumatology, 26716Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.,26716Hanyang University Institute for Rheumatology Research, Seoul, South Korea
| | - Soo-Kyung Cho
- Department of Rheumatology, 26716Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.,26716Hanyang University Institute for Rheumatology Research, Seoul, South Korea
| | - Eunwoo Nam
- Department of Rheumatology, 26716Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.,26716Hanyang University Institute for Rheumatology Research, Seoul, South Korea
| | - Hyoungyoung Kim
- Department of Rheumatology, 26716Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.,26716Hanyang University Institute for Rheumatology Research, Seoul, South Korea
| | - Shin-Seok Lee
- Division of Rheumatology, 65417Chonnam National University Medical School and Hospital, Gwangju, South Korea
| | - Meenakshi Jolly
- Department of Medicine, 2468Rush University Medical Center, Chicago, IL, USA
| | - Yoon-Kyoung Sung
- Department of Rheumatology, 26716Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea.,26716Hanyang University Institute for Rheumatology Research, Seoul, South Korea
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17
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Gao RC, Wu L, Shi PL, Sang N, Hao M, Wu GC. The impact of distress disclosure and anxiety on the association between social support and quality of life among Chinese women with systemic lupus erythematosus. Front Psychiatry 2022; 13:893235. [PMID: 35990077 PMCID: PMC9385970 DOI: 10.3389/fpsyt.2022.893235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/12/2022] [Indexed: 11/28/2022] Open
Abstract
The evidence on the relationship between social support and quality of life in female systemic lupus erythematosus (SLE) patients is complex. The purpose of this study was to explore the impacts of distress disclosure and anxiety on the association between social support and quality of life among Chinese women with SLE. A cross-sectional study was conducted, and 237 samples were obtained. Measures included demographic characteristics, Lupus Quality of Life (LupusQoL), social support rate scale (SSRS), distress disclosure index (DDI), and self-rating anxiety scale (SAS). Descriptive statistics, correlation analysis, and moderated mediating effect analysis were carried out. The LupusQoL was negatively correlated with age, systemic lupus erythematosus disease activity index (SLEDAI), DDI, and SAS. SSRS had a positive predictive effect on the LupusQoL, while SLEDAI and DDI had the opposite effect. SAS had a negative predictive effect on the LupusQoL. There were interactive effects of SAS and DDI on LupusQoL. In the moderated mediation model, SAS played moderating effect in the role of DDI on LupusQoL; the DDI of female patients with SLE played a partial mediator role, the mediation effect was 0.19, and the mediation effect ratio was 33.3%. In conclusion, to pay attention to the QOL, we should consider the mediator role of distress disclosure and the moderating role of anxiety.
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Affiliation(s)
- Rui-Chen Gao
- School of Nursing, Anhui Medical University, Hefei, China
| | - Li Wu
- School of Nursing, Anhui Medical University, Hefei, China
| | - Pei-Li Shi
- School of Nursing, Anhui Medical University, Hefei, China
| | - Ni Sang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Min Hao
- Department of Rheumatology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Guo-Cui Wu
- School of Nursing, Anhui Medical University, Hefei, China
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18
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Campos-Guzmán J, Valdez-López M, Govea-Peláez S, Aguirre-Aguilar E, Perez-Garcia LF, van Mulligen E, Castillejos-Molina R, Barrera-Vargas A, Merayo-Chalico J. Determinants of sexual function in male patients with systemic lupus erythematosus. Lupus 2022; 31:1211-1217. [PMID: 35702930 DOI: 10.1177/09612033221107802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Our study aims to describe the association between SLE and sexual function, analysing demographic variables, comorbidities and other disease-related factors. As an exploratory objective, the impact of asking about sexual function during outpatient consultation was evaluated. METHODS From 2018 to 2019, we invited sexually active men diagnosed with SLE to complete questionnaires that evaluated their sexual function and quality of life. Additionally, patients were asked if they believed they had sexual dysfunction, whether they would be interested in receiving specialized sexual care, and if they considered SLE to be detrimental to their sexual function. Epidemiological and disease-related data were retrieved from the patients' clinical records. RESULTS We included 124 men with SLE. Twenty-two (18%) patients answered positively when asked if they believed they had sexual dysfunction. These patients had lower overall erectile function scores and lower physical function scores than those who did not consider they had sexual dysfunction. In the multivariable analysis, factors that were associated with better sexual function were high physical function (B = 0.126, p = .031), lower BMI (B = 0.53, p = .010) and the patient's perception of normal sexual function (B = 13.0, p < .001). Comorbidities associated with worse sexual function were type 2 diabetes (B = -8.1, p = .017) and a history of thrombosis (B = -5.12, p = .019). CONCLUSION Sexual function of male patients with SLE is impaired, independently of disease activity, chronic disease damage or pharmacological treatment. A simple question about perception of sexual function in the outpatient clinic can be used to help determine which patients could benefit from a multidisciplinary intervention to improve sexual health.
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Affiliation(s)
- Jonathan Campos-Guzmán
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Martín Valdez-López
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Samuel Govea-Peláez
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Eduardo Aguirre-Aguilar
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Luis F Perez-Garcia
- Department of Rheumatology, 6993Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Elise van Mulligen
- Department of Rheumatology, 6993Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ricardo Castillejos-Molina
- Department of Urology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Ana Barrera-Vargas
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
| | - Javier Merayo-Chalico
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico
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19
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Chen Y, Wang L, Cao Y, Li N. Total Glucosides of Paeonia lactiflora for Safely Reducing Disease Activity in Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis. Front Pharmacol 2022; 13:834947. [PMID: 35173622 PMCID: PMC8841895 DOI: 10.3389/fphar.2022.834947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 01/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Total glucosides of paeony (TGP), extracted from the dried roots of Paeonia lactiflora Pall., are proven to regulate immune function in various rheumatic diseases. We aim to systematically evaluate the efficacy and safety of TGP in reducing disease activity in systemic lupus erythematosus (SLE). Methods: We searched trials in seven electronic databases and two clinical trail registries. Randomized controlled trials (RCTs) evaluating efficacy and safety of TGP for SLE were identified. The Cochrane Risk of Bias Tool 2.0 was used for quality assessment of the included trials, and RevMan 5.4 software was used for meta-analysis. Results: A total of 14 RCTs were included, including 978 participants, 492 in the intervention group and 486 in the control group. Regarding the efficacy of TGP for SLE, results showed that TGP plus conventional treatments (CTs) was superior to CTs alone in reducing disease activity (MDSLEDAI-1m = −3.54, 95% CI = −4.08 to −3.00, p < 0.00001; MDSLEDAI-2m = −3.80, 95% CI = −4.51 to −3.09, p < 0.00001; MDSLEDAI-3m = −1.62, 95% CI = −2.60 to −0.64, p < 0.0001; MDSLEDAI-6m = −1.97, 95% CI = −3.18 to −0.76, p = 0.001). The results also showed that TGP contributed to a betterment in improving other outcomes related to lupus activity, such as ESR, CRP, complement proteins (C3, C4), and immunoglobulins (IgA, IgM). In addition, TGP significantly decreased average daily glucocorticoid dosage and cumulative cyclophosamide dosage, as well as disease recurrence rate. In terms of safety, TGP may reduce the incidence of adverse reactions (RR = 0.51, 95% CI = 0.29 to 0.88, p = 0.01). The certainty of the evidence were assessed as moderate to low. Conclusion: TGP appears potentially effective and generally safe in reducing disease activity in SLE. However, in view of high risk of bias, the findings need to be confirmed in high-quality trials. Systematic Review Registration: https://www.crd.york.ac.uk/prospero, identifier CRD42021274850
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Affiliation(s)
- Yifan Chen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Liuding Wang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yu Cao
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Nannan Li
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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20
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Radin M, El Hasbani G, Barinotti A, Roccatello D, Uthman I, Taher A, Sciascia S. Quality of life measures in Systemic Lupus Erythematosus: A systematic review. Reumatismo 2022; 73. [DOI: 10.4081/reumatismo.2021.1447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
In this study we systematically investigated the health-related quality of life (HRQoL) tools, which have been most often used over the last five years to evaluate the QoL in patients with systemic lupus erythematosus (SLE), focusing on their items and applications. A detailed literature search was conducted: the inclusion criteria were as follows: 1) studies including at least 50 patients; 2) studies including at least 25 patients with SLE; 3) quality of life testing with validated measures. The systematic review was based on 119 studies for a total of 32,449 SLE patients and 3092 controls. A total of 35 different patients-reported quality of life measures, applied in cohorts of patients with SLE, were retrieved with the 36-item Medical Outcome Short Form (SF-36) (63 studies of 119 =52.95%), Lupus Quality of Life (LupusQoL) (17 studies =14.3%) and Lupus Patient-Reported Outcome (LupusPRO) (12 studies =10%) being the most commonly used tools. Overall, this systematic review of the literature indicated that quality of life in patients with SLE appears to be poor and generally lower compared to both the general population and patients with other chronic conditions, as was shown by a few studies that used SF-36 and LupusPRO. The use of HRQoL scoring in SLE is gaining increasing interest and is used both in randomized controlled trials and in real-life. Future efforts are needed to improve the understanding of the impact of the disease burden on quality of life from the patient’s perspective.
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21
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Escoda T, Jourde-Chiche N, Cornec D, Chiche L. [Toward a better clinical stratification of patients with autoimmune diseases to improve research and care within its biopsychosocial dimensions]. Rev Med Interne 2022; 43:71-74. [PMID: 35000766 DOI: 10.1016/j.revmed.2021.10.337] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/28/2021] [Indexed: 01/24/2023]
Affiliation(s)
- T Escoda
- Service de médecine interne, hôpital Européen, Marseille, France
| | - N Jourde-Chiche
- Service de néphrologie, hôpital de la Conception, Marseille, France
| | - D Cornec
- Service de rhumatologie, hôpital de la Cavale Blanche, Brest, France
| | - L Chiche
- Service de médecine interne, hôpital Européen, Marseille, France.
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22
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Tan G, Huang B, Cui Z, Dou H, Zheng S, Zhou T. A noise-immune reinforcement learning method for early diagnosis of neuropsychiatric systemic lupus erythematosus. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:2219-2239. [PMID: 35240783 DOI: 10.3934/mbe.2022104] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The neuropsychiatric systemic lupus erythematosus (NPSLE), a severe disease that can damage the heart, liver, kidney, and other vital organs, often involves the central nervous system and even leads to death. Magnetic resonance spectroscopy (MRS) is a brain functional imaging technology that can detect the concentration of metabolites in organs and tissues non-invasively. However, the performance of early diagnosis of NPSLE through conventional MRS analysis is still unsatisfactory. In this paper, we propose a novel method based on genetic algorithm (GA) and multi-agent reinforcement learning (MARL) to improve the performance of the NPSLE diagnosis model. Firstly, the proton magnetic resonance spectroscopy (1H-MRS) data from 23 NPSLE patients and 16 age-matched healthy controls (HC) were standardized before training. Secondly, we adopt MARL by assigning an agent to each feature to select the optimal feature subset. Thirdly, the parameter of SVM is optimized by GA. Our experiment shows that the SVM classifier optimized by feature selection and parameter optimization achieves 94.9% accuracy, 91.3% sensitivity, 100% specificity and 0.87 cross-validation score, which is the best score compared with other state-of-the-art machine learning algorithms. Furthermore, our method is even better than other dimension reduction ones, such as SVM based on principal component analysis (PCA) and variational autoencoder (VAE). By analyzing the metabolites obtained by MRS, we believe that this method can provide a reliable classification result for doctors and can be effectively used for the early diagnosis of this disease.
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Affiliation(s)
- Guanru Tan
- Department of Computer Science, Shantou University, Shantou 515063, China
| | - Boyu Huang
- Department of Computer Science, Shantou University, Shantou 515063, China
| | - Zhihan Cui
- Department of Computer Science, Shantou University, Shantou 515063, China
| | - Haowen Dou
- Department of Computer Science, Shantou University, Shantou 515063, China
| | - Shiqiang Zheng
- Department of Computer Science, Shantou University, Shantou 515063, China
| | - Teng Zhou
- Department of Computer Science, Shantou University, Shantou 515063, China
- Key Laboratory of Intelligent Manufacturing Technology, Shantou University, Ministry of Education, Shantou 515063, China
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Effects of Exercise Intervention on Health-Related Quality of Life in Patients with Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis of Controlled Trials. Healthcare (Basel) 2021; 9:healthcare9091215. [PMID: 34574989 PMCID: PMC8468902 DOI: 10.3390/healthcare9091215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/11/2021] [Accepted: 09/14/2021] [Indexed: 01/02/2023] Open
Abstract
Exercise and physical activity have been deemed as potentially beneficial for patients with systemic lupus erythematosus (SLE). This study aimed to evaluate the effects of exercise interventions on health-related quality of life in patients with SLE using a systematic review and meta-analysis. Randomized and non-randomized controlled trials published up to July 2021 were examined using the PubMed and Embase databases. Of the 1158 articles retrieved, nine were included for systematic review. Five of them were randomized controlled trials and these were assessed using meta-analysis. Hedges’ g effect size was 0.47; 95% (confidence interval 0.21–0.73; p < 0.001) for the physical health and function aspect of health-related quality of life. None of the other seven domains of the SF-36 showed a significant effect size. However, the latter finding was limited by the small number of available trials. In conclusion, this systematic review and meta-analysis supported that exercise intervention compared to usual care might be able to improve the physical functioning domain of health-related quality of life in patients with SLE. Future high-quality randomized controlled trials that incorporate disease-specific health-related quality of life measures are needed to elucidate the role of exercise on health-related quality of life in patients with SLE.
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Sloan M, Lever E, Gordon C, Harwood R, Georgopoulou S, Naughton F, Wincup C, Sutton S, D'Cruz D. Medication decision-making and adherence in lupus: Patient-physician discordance and the impact of previous 'Adverse Medical Experiences'. Rheumatology (Oxford) 2021; 61:1417-1429. [PMID: 34247235 PMCID: PMC8996780 DOI: 10.1093/rheumatology/keab534] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/27/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives Medication adherence is critical in the successful management of lupus. There is very limited existing literature on reasons why non-adherence is not reported. This study explores the impact of current and previous medical experiences on patient satisfaction, adherence and reporting of non-adherence. Methods Mixed methodology involved thematic analysis of in-depth interviews (n = 23) to further explore the statistically analysed quantitative survey findings (n = 186). Results This study identified five themes: (i) physician-patient discordance and a ‘hierarchy of evidence’ in medication decisions; (ii) the association of adherence with satisfaction with care; (iii) the persisting impact of past adverse medical experiences (AMEs); (iv) the dynamic balance of patient-physician control; and (v) holistic care, beyond a purely medication-based focus. Improving quality of life (43% of participants) and a supportive medical relationship (24%) were the main reasons for adherence. Patient-priorities and self-reported symptoms were perceived as less important to physicians than organ-protection and blood results. Non-reporters of non-adherence, non-adherers and those with past AMEs (e.g. psychosomatic misdiagnoses) had statistically significant lower satisfaction with care. The importance of listening to patients was a key component of every theme, and associated with patient satisfaction and adherence. The mean rating for rheumatologist’s listening skills was 2.88 for non-adherers compared with 3.53 for other participants (mean difference 0.65, P = 0.003). Conclusion Patients would like more weight and discussion given to self-reported symptoms and quality of life in medication decisions. Greater understanding and interventions are required to alleviate the persisting impact of past AMEs on some patients’ wellbeing, behaviour and current medical relationships.
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Affiliation(s)
- Melanie Sloan
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK
| | - Elliott Lever
- Rheumatology department, Northwick Park Hospital, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of inflammation and ageing, College of Medical and Dental Science, University of Birmingham, UK
| | - Rupert Harwood
- Patient and Public Involvement in lupus Research Group, Institute of Public Health, University of Cambridge, UK
| | | | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, UK
| | - Chris Wincup
- Department of Rheumatology, University College London, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK
| | - David D'Cruz
- The Louise Coote Lupus unit, Guy's and St Thomas', NHS foundation Trust, UK
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25
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Monahan RC, Beaart-van de Voorde LJ, Eikenboom J, Fronczek R, Kloppenburg M, Middelkoop HA, Terwindt GM, van der Wee NJ, Huizinga TW, Steup-Beekman GM. Fatigue in patients with systemic lupus erythematosus and neuropsychiatric symptoms is associated with anxiety and depression rather than inflammatory disease activity. Lupus 2021; 30:1124-1132. [PMID: 33779389 PMCID: PMC8120630 DOI: 10.1177/09612033211005014] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION We aimed to investigate risk factors for fatigue in patients with systemic lupus erythematosus (SLE) and neuropsychiatric symptoms in order to identify potential interventional strategies. METHODS Patients visiting the neuropsychiatric SLE (NPSLE) clinic of the Leiden University Medical Center between 2007-2019 were included. In a multidisciplinary consensus meeting, SLE patients were classified as having neuropsychiatric symptoms of inflammatory origin (inflammatory phenotype) or other origin (non-inflammatory phenotype). Fatigue was assessed with the SF-36 vitality domain (VT) since 2007 and the multidimensional fatigue inventory (MFI) and visual analogue scale (VAS) since 2011. Patients with a score on the SF-36 VT ≥1 standard deviation (SD) away from the mean of age-related controls of the general population were classified as fatigued; patients ≥2 SD away were classified as extremely fatigued. Disease activity was measured using the SLE disease activity index-2000. The influence of the presence of an inflammatory phenotype, disease activity and symptoms of depression and anxiety as measured by the hospital anxiety and depression scale (HADS) was analyzed using multiple regression analyses corrected for age, sex and education. RESULTS 348 out of 371 eligible patients filled in questionnaires and were included in this study . The majority was female (87%) and the mean age was 43 ± 14 years. 72 patients (21%) had neuropsychiatric symptoms of an inflammatory origin. Fatigue was present in 78% of all patients and extreme fatigue was present in 50% of patients with an inflammatory phenotype vs 46% in the non-inflammatory phenotype. Fatigue was similar in patients with an inflammatory phenotype compared to patients with a non-inflammatory phenotype on the SF-36 VT (β: 0.8 (95% CI -4.8; 6.1) and there was less fatigue in patients with an inflammatory phenotype on the MFI and VAS (β: -3.7 (95% CI: -6.9; -0.5) and β: -1.0 (95% CI -1.6; -0.3)). There was no association between disease activity and fatigue, but symptoms of anxiety and depression (HADS) associated strongly with all fatigue measurements. CONCLUSION This study suggests that intervention strategies to target fatigue in (NP)SLE patients may need to focus on symptoms of anxiety and depression rather than immunosuppressive treatment.
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Affiliation(s)
- Rory C Monahan
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jeroen Eikenboom
- Department of Internal Medicine, Division of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Rolf Fronczek
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Sleep-Wake Center SEIN, Heemstede, the Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Huub Am Middelkoop
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, the Netherlands
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nic Ja van der Wee
- Department of Psychiatry, Leiden University Medical Center, Leiden, the Netherlands
| | - Tom Wj Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gerda M Steup-Beekman
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Rheumatology, Haaglanden Medical Center, the Hague, the Netherlands
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26
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Tani C. Lupus in the 21st century. Rheumatology (Oxford) 2021; 59:v1-v3. [PMID: 33280010 PMCID: PMC7719034 DOI: 10.1093/rheumatology/keaa673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/07/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Chiara Tani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
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